Sunday, January 8, 2012

Specialist medical training and practice in Australia arose from the model of postgraduate advanced clinical training developed in the United Kingdom. National specialist medical colleges set the standards of training and coordinate the training, education and examination of medical specialists in Australia. The areas of medical practice assessed by the specialist colleges in Australia are set out in.

The areas of approved medical specialties are listed in the AMC List of Australian Recognised Medical Specialties. The list includes those organisations, specialties and qualifications that are recognised and approved by the Australian Minister for Health and Ageing.

The table and the AMC list differ, as the areas of medical practice assessed by specialist medical colleges includes emerging areas yet to be approved as new medical specialties.

Applicants for specialist assessment are expected to have satisfied all the training and examination requirements to practise in their field of specialty in their country of training. The standard applied to the assessment of overseas-trained specialists is the standard required for admission to the relevant specialist medical college as a Fellow. Since January 2009, applicants have been required to also demonstrate evidence of English Language Proficiency prior to assessment by the relevant specialist medical college. Where components of the college's examination and assessment procedures are applied, they are the same as, or derived from, those that apply to local specialist trainees.

The AMC has received advice from the Royal Australian & New Zealand College of Obstetricians & Gynaecologists (RANZCOG), advising that if an applicant's specialist training was completed in Malaysia the applicant will need to include in their application a 'Gazetted' letter confirming the date they were recognised as a specialist in obstetrics and gynaecology in Malaysia.

The AMC has received advice from the Australian and New Zealand College of Anaesthetists (ANZCA), advising that Sri Lankan applicants must have completed their specialist training and examinations plus two years further experience in either the United Kingdom or Australia to be considered as an independent specialist in Sri Lanka. As an applicant must be recognised as an independent specialist in their country of training, any Sri Lankan applicants seeking assessment through ANZCA must meet this requirement to be eligible.

Area of Need Specialist Pathway

From June 2002, arrangements have been introduced to fast-track the processing of applications from overseas-trained specialists, whose primary medical qualifications are not recognised in Australia, for assessment for Area of Need specialist positions.

The documentation requirements and arrangements for processing Area of Need Specialist Pathway applications are broadly similar to those for applications through the Standard AMC/Specialist Pathway for overseas-trained specialists. However, there are some differences because of the need to process Area of Need Specialist Pathway applications rapidly and in parallel with the assessing college.

If you are considering applying for the AMC Area of Need Specialist Pathway, you should note carefully the requirements and the steps involved.

Before your application can be processed, you must have been selected by an employer as suitable for consideration for appointment to a designated area of need specialist position.

Details of the position must be provided on the application to determine eligibility to be assessed for appointment as an area of need specialist form at the time the employer lodges the required documentation on your behalf.

Overseas trained doctors have become an important part of the Australian medical workforce and there are a set of processes which have been developed to assess and recognise the skills and qualifications of overseas trained medical professionals. A part of this process includes meeting English language proficiency requirements. It is therefore essential that doctors and other medical professionals improve English communication skills to ensure effective patient care.

To be a practicing doctor in Australia, overseas trained doctors must meet the Medical Registration Board language requirements plus the English language proficiency requirements as set by the Australian Medical Council (AMC).

Australia is an English speaking country, therefore it is essential that overseas trained doctors have a very good knowledge and understanding of the English language. Having good English language skills enables doctors to communicate with their patients, other doctors and health professionals, and to keep up to date with medical information and research.

In all Australian states and territories, proficiency in English is a legislative requirement for registration of overseas trained doctors. All applicants are required to undertake and successfully complete one of the English language proficiency tests recognised by the AMC. Two of the tests are the International English Language Testing System and the Occupational English Test. Both of these tests include a speaking component which may involve the candidate speaking about a workplace situation.

The requirements are that the candidate must complete the IELTS examination (academic module) with a minimum score of 7 in each of the four components (listening, reading, writing and speaking); or completion and an overall pass in the OET with grades A or B only in each of the four components; or successful completion of the NZREX; or PLAB test.

The next step is to pass the Australian Medical Council Examination. The AMC Examination has been developed to assess the medical knowledge and clinical skills of overseas trained doctors whose basic medical qualifications are not recognised by the state or territory.

Both examinations include questions that address a number of medical principles at the same time. The clinical examination also assesses the candidate’s capacity to communicate with patients, patients’ families and other health workers.

The AMC Examination consists of two parts, a Multiple Choice Questionnaire (MCQ) Examination and a Clinical Examination. The clinical examination includes a consulting skills assessment which includes simulated case scenarios incorporating role plays. Assessment is based on performance in rapport building, examination technique, accuracy of findings, diagnosis, management, investigations, procedures and counselling.

On passing the clinical section, a candidate will be awarded an AMC Certificate. The certificate will entitle an overseas trained doctor to apply for registration in any state or territory of Australia, subject to the requirements of each state or territory Medical Board. This usually includes one year of supervised medical practice. Further information can be found by checking the website of the Australian Medical Council.

The Australian Medical Council (AMC) is the Australian national standards advisory body for medical education and training.

Its mission statement is:"To promote and protect public health and safety by ensuring a safe and competent workforce distributed across Australia to meet community needs."

Within Australia, it:

Accredits Australian and New Zealand medical schools and medical coursesAccredits Australian/Australasian programs of specialist medical trainingAdvises on the recognition of medical specialties and sub-specialtiesAssesses overseas trained medical doctors who wish to practise medicine in AustraliaAdvises State and Territory Medical Boards on uniform approaches to the registration of medical practitioners and maintains a national network of State and Territory medical registersAdvises the Australian Health Ministers' Advisory Council on the registration of doctors

Those who wish to take up a period of limited registration (which you can do only if you are in supervised employment) and who need evidence that they have the necessary skills and knowledge to practise medicine in the UK.

The PLAB test is designed to test ones ability to work safely in a first appointment as a senior house officer in a UK hospital in the National Health Service (NHS).

The Professional and Linguistic Assessment Board test (PLAB) is the assessment procedure conducted by the General Medical Council of the United Kingdom that is required for overseas doctors outside the European Union before they can practice medicine in the UK.

The PLAB test has 2 parts:

Has EMQs (extended matching questions) and SBAs (Single Best Answer questions), This part is conducted in a number of countries including Egypt (Cairo), India, Pakistan, Nigeria, Sri Lanka, Bangladesh.

Part 2 : Consists of an objective structured clinical examination (OSCE). This Part is available only in United Kingdom. It consists of 14 clinical stations, a pilot station and a rest station. The pilot station is usually unannounced and mixed with the clinical stations. The marks for the pilot station do not count towards the final score. All the stations are of five minutes duration. The level of difficulty of the clinical part of the PLAB exam is set at the level of competence of a senior house officer (SHO) in a first appointment in a UK hospital. The skills assessed in this exam are: clinical examination, practical skills, communication skills, and history taking.

The following is a brief list of some of the things I think have been useful and worth their money in my first two years of med school:

1. Large, widescreen computer monitor. The volume of information required to internalize during the preclinical years of medical school can’t be compiled and organized on paper. You would end up with bookshelves filled with those gigantic 4″ binders. Therefore, almost everything happens on a laptop. Of course, the advantages of portability afforded by laptops are offset by the tiny screen size. Plugging into an external, gigantic screen when at home is a huge advantage. You can actually see what you need to be looking at. It’s brighter and generally has better resolution. More important, the additional real estate allows you to have multiple windows open side-by-side so you can take notes in one and look at material or watch videos in the other.2. Robbins Pathologic Basis of Disease. One of our professors once said, “You could lock a med student in a basement for two years with a copy of Robbins and they would come out and not miss a question on Step 1.” A single textbook doesn’t exist for medical school, but this one pretty much covers everything you need to know in the first two years. Unfortunately, Robbins often goes into too much detail, but it is the best reference book for anything during the preclinical years. This is a required book for any med student.

3. Smartphone. If for nothing else, to keep track of your email and schedule. I don’t know exactly how much email I get in a given day, but it’s a lot. Being able to check these emails anytime without sitting down at a computer is a huge advantage. The other thing smartphones are getting better and better at is on-the-go studying. I can pull up a set of anatomy flashcards while I’m waiting for a meeting to start and quickly hit high-yield information. You can also use it for quick reference while in the clinics — either to teach yourself about a condition/medication relating to a patient or help out your preceptor/attending (be careful with this one, though, they might not appreciate your help).

4. A decent stethoscope. The key word here is “decent.” Get one better than the base model, but don’t go out and drop $500 on an electronic cardiology stethoscope — (1) you’ll look like an idiot, (2) it’s not worth it at this point and (3) you’ll probably lose it at some point. A good quality stethoscope will help tremendously, both in terms of hearing what you’re supposed to be hearing and comfort.

5. A good bed. You may not get a lot of sleep, so what you do get you want to be very good.

6. Question and review books. Hundreds of question and review books exist. Some advise med students against getting any of these until they are actually preparing for Step 1. The fear is two-fold:

Students will use review books as a primary source for studying and miss out on some of the nuance provided by studying actual textbooks or materials from professors.

Students will become too focused on prep Step 1 and look past the fact that they need to focus on their current courses and pass them.

Both risks are very real for students. However, review books and question books can effectively be incorporated into normal test prep during coursework in Year 1 and 2. The benefit of using these tools in your preparation for regular course tests is that you become familiar with these materials before you begin your arduous Step 1 preparation. Also, many of the review books contain very helpful mnemonics and tools for memorizing complicated pathways or concepts. Instead of wasting time coming up with your own, often inferior, memorization tools you can use some of the most effective ones from previous students. But don’t fall into the aforementioned traps — study primary materials first and only use these as your last bit of review/self-testing before an exam.

7. A good anatomy atlas. I think it’s important to have a true anatomy atlas, meaning one that is simply labeled pictures/diagrams. Several anatomy texts exist that are a combination textbook and atlas. I generally don’t like these because I find the text only functions to make the book thicker and makes finding the diagram you want difficult.

8 . Not over-paying for med school. A recent study in the Archives of Internal Medicine showed physicians who went to med school at US News & World Report Top 10 research or primary care medical schools did not perform any better on quality measures than their peers who went to less prestigious institutions. Med school debt is bad enough, don’t exacerbate the problem.

Nurses will treat you badly, simply because you are a medical student.

There will be times when you’ll be ignored by your attending or resident.

You will develop a thick skin. If you fail to do this, you’ll cry often.

Public humiliation is very commonplace in medical training.

Surgeons are assholes. Take my word for it now.

OB/GYN residents are treated like shit, and that shit runs downhill. Be ready to pick it up and sleep with it.

It’s always the medical student’s fault.

Gunner is a derogatory word. It’s almost as bad as racial slurs.

You’ll look forward to the weekend, not so you can relax and have a good time but so you can catch up on studying for the week.

Your house might go uncleaned for two weeks during an intensive exam block.

As a medical student on rotations, you don’t matter. In fact, you get in the way and impede productivity.

There’s a fair chance that you will be physically struck by a nurse, resident, or attending physician. This may include slapped on the hand or kicked on the shin in order to instruct you to “move” or “get out of the way.”

Any really bad procedures will be done by you. The residents don’t want to do them, and you’re the low man on the totem pole. This includes rectal examinations and digital disimpactions.

You’ll be competing against the best of the best, the cream of the crop. This isn’t college where half of your classmates are idiots. Everybody in medical school is smart.

Don’t think that you own the world because you just got accepted into medical school. That kind of attitude will humble you faster than anything else.

If you’re in it for the money, there are much better, more efficient ways to make a living. Medicine is not one of them.

Anatomy sucks. All of the bone names sound the same.

If there is anything at all that you’d rather do in life, do not go into medicine.

The competition doesn’t end after getting accepted to medical school. You’ll have to compete for class rank, awards, and residency. If you want to do a fellowship, you’ll have to compete for that too.

You’ll never look at weekends the same again.

VA hospitals suck. Most of them are old, but the medical records system is good.

Your fourth year in medical school will be like a vacation compared to the first three years. It’s a good thing too, because you’ll need one.

Somebody in your class will be known as the “highlighter whore.” Most often a female, she’ll carry around a backpack full of every highlighter color known to man. She’ll actually use them, too.

Rumors surrounding members of your class will spread faster than they did in high school.

You’ll meet a lot of cool people, many new friends, and maybe your husband or wife.

No matter how bad your medical school experience was at times, you’ll still be able to think about the good times. Kind of like how I am doing right now.

Your first class get-together will be the most memorable. Cherish those times.

Long after medical school is over, you’ll still keep in contact with the friends you made. I do nearly every day.

Gunners always sit in the front row. This rule never fails. However, not everyone who sits in the front row is a gunner.

There will be one person in your class who’s the coolest, most laid back person you’ve ever met. This guy will sit in the back row and throw paper airplanes during class, and then blow up with 260+ Step I’s after second year. True story.

At the beginning of first year, everyone will talk about how cool it’s going to be to help patients. At the end of third year, everybody will talk about how cool it’s going to be to make a lot of money.

Students who start medical school wanting to do primary care end up in dermatology. Those students who start medical school wanting to do dermatology end up in family medicine.

Telling local girls at the bar that you’re a medical student doesn’t mean shit. They’ve been hearing that for years. Be more unique.

The money isn’t really that good in medicine. Not if you look at it in terms of hours worked.

Don’t wear your white coat into the gas station, or any other business that has nothing to do with you wearing a white coat. You look like an ass, and people do make fun of you.

Don’t round on patients that aren’t yours. If you round on another student’s patients, that will spread around your class like fire after a 10 year drought. Your team will think you’re an idiot too.

If you are on a rotation with other students, don’t bring in journal articles to share with the team “on the fly” without letting the other students know. This makes you look like a gunner, and nobody likes a gunner. Do it once, and you might as well bring in a new topic daily. Rest assured that your fellow students will just to show you up.

If you piss off your intern, he or she can make your life hell.

If your intern pisses you off, you can make his or her life hell.

Don’t try to work during medical school. Live life and enjoy the first two years.

Not participating in tons of ECs doesn’t hurt your chances for residency. Forget the weekend free clinic and play some Frisbee golf instead.

Don’t rent an apartment. If you can afford to, buy a small home instead. I saved $200 per month and had roughly $30,000 in equity by choosing to buy versus rent.

Your family members will ask you for medical advice, even after your first week of first year.

Many of your friends will go onto great jobs and fantastic lifestyles. You’ll be faced with 4 more years of debt and then at least 3 years of residency before you’ll see any real earning potential.

Pick a specialty based around what you like to do.

At least once during your 4 year stay, you’ll wonder if you should quit.

It’s amazing how fast time flies on your days off. It’s equally amazing at how slow the days are on a rotation you hate.

You’ll learn to be scared of asking for time off.

No matter what specialty you want to do, somebody on an unrelated rotation will hold it against you.

A great way to piss of attendings and residents are to tell them that you don’t plan to complete a residency.

Many of your rotations will require you to be the “vitals bitch.” On surgery, you’ll be the “retractor bitch.”

Sitting around in a group and talking about ethical issues involving patients is not fun.

If an attending or resident treats you badly, call them out on it. You can get away with far more than you think.

Going to class is generally a waste of time. Make your own schedule and enjoy the added free time.

Find new ways to study. The methods you used in college may or may not work. If something doesn’t work, adapt.

Hospitals smell bad.

Subjective evaluations are just that – subjective. They aren’t your end all, be all so don’t dwell on a poor evaluation. The person giving it was probably an asshole, anyway.

Some physicians will tell you it’s better than it really is. Take what you hear (both positive and negative) with a grain of salt.

90% of surgeons are assholes, and 63% of statistics are made up. The former falls in the lucky 37%.

The best time of your entire medical school career is between the times when you first get your acceptance letter and when you start school.

During the summer before medical school starts, do not attempt to study or read anything remotely related to medicine. Take this time to travel and do things for you.

The residents and faculty in OB/GYN will be some of the most malignant personalities you’ve ever come into contact with.

Vaginal deliveries are messy. So are c-sections. It’s just an all-around blood fest if you like that sort of thing.

Despite what the faculty tell you, you don’t need all of the fancy equipment that they suggest for you to buy. All you need is a stethoscope. The other equipment they say you “need” is standard in all clinic and hospital exam rooms. If it’s not standard, your training hospital and clinics suck.

If your school has a note taking service, it’s a good idea to pony up the cash for it. It saves time and gives you the option of not attending lecture.

Medicine is better than being a janitor, but there were times when I envied the people cleaning the hospital trash cans.

Avoid surgery like the plague.

See above and then apply it to OB/GYN as well.

The money is good in medicine, but it’s not all that great especially considering the amount of time that you’ll have to work.

One time an HIV+ patient ripped out his IV and then “slung” his blood at the staff in the room. Go, go infectious disease.

Read Med School Hell now, throughout medical school, and then after you’re done. Then come back and tell me how right I am.

Studying for the USMLE Step 1 exam is serious business, and we are now in a time where there are more applicants than there are available residency positions, so there is absolutely no room for error in preparing for it thoroughly. It's true, there are almost twice as many people applying for residency today than there are available positions, so students should no longer be striving to simply "pass" the exam and go into a primary care field, because even the simplest residency programs to get into are now extremely competitive.

Because of the increasing difficulty in attaining a residency and the direct relationship between getting interviews and a good Step 1 score, I am going to share seven tips that I believe can help anybody do well on the USMLE exam, even if you are not a strong test-taker.

My seven tips for an outstanding Step 1 score are:

#1 - Start thinking USMLE from day 1 of med school

Get into the mindset from day 1 that you are preparing for the boards, because the sooner you set your mind for it's preparation the sooner you will start to absorb the appropriate material.

#2 - Class time = USMLE prep time

Pay close attention throughout your courses and pay extra attention to anything that your professors say is "high-yield", because they have been there already and they know what is likely to be on the exam. Take notes and develop your own process for marking the high-yield stuff that comes up in your classes.

#3 - Give the USMLE 1 hour every week from the start

If you are taking the right steps and making notes consistently for the Step 1 then you should have an ever-growing set of USMLE notes. Every week, take only 1 hour and sit and study your USMLE-specific notes, which will help you to absorb the high-yield information over time and this will ultimately help you best prepare.

#4 - Combine your class notes with your study guide notes

Something I didn't do but I wish I had done was get a USMLE Step 1 study guide from day 1 and bring it to all my classes. I had friends who did this and it helped them tremendously, and the only thing you need to do is jot down class information that comes up that is discussed in your study guide. This helps you to add more depth to the high-yield topics mentioned in the study guide and this ultimately gives you an even better study guide in the long-run.

#5 - Do a question bank from day 1

Starting a question bank from the beginning of your med school days is a great way to learn how to take standardized exam questions as well as a great way to help you prepare for your classes. Be sure to work through the qbanks slowly and take great notes along the way, as these will come in handy closer to your Step 1 exam date.

#6 - Create 3 sets of notes for the USMLE

Studying simply from a pre-written study guide is a fast way to a mediocre score, so instead of that you want to create 3 sets of study notes for your USMLE prep. First, you need to create notes straight from your classes which are your most in-depth set of study notes, secondly you need a set of notes mentioned in #4 which is more high-yield in nature, and third you need a thorough set of notes taken from your question bank. These three are a killer combination and will help you do very well on your exam.

#7 - Treat your USMLE preparation like a job

This test is tough, so approach it as if it was a job, giving it plenty of dedicated attention. When you are done with your 1st and 2nd year courses, create a schedule for studying and stick to it firmly, as you need to study intensely and consistently for a few weeks in order to get a top score.

Admit it, in medical school, you have to juggle between lecture, classes, laboratories, and your personal and social life, such that you most probably review for a major examination a week or a day before the of test. And every time you gather with your colleagues, you huddle together and do a post-mortem of the test questions, right? In your mind, there's a small voice saying "You could have done better if you prepared properly." Then you start promising yourself that the next time will be different, but you only repeat the same process over and over again.

If you pass your medical school examinations, that means you have the capacity for memory retention, right? If you allocated enough time to your USMLE review, you could be at the top of the class, right? When your professors remind you to prepare for a test - then by all means, a medical student should be prepared. Why? Because you will later on deal with actual diseases and diagnoses, and prescribe actual medical or surgical interventions to real patients!

A medical student should never go to class unprepared, the same way that the doctor should never enter the =patient's room without proper training.Have you heard the old saying, "What you sow today, you reap tomorrow?" Indeed, where you invest your time now as a medical student will define the physician that you are tomorrow.

With the fast evolution of technology, the information printed on your textbook (three years out of date, on average) may have changed, and what better way to prepare yourself for the medical board examinations than to do some serious USMLE review.

You can always study on your own with books open, but when help is available to give you the proper preparation to secure the next 25 years of your medical career, wouldn't you grab that chance? Here are several reasons why you should participate in a formal or informal, up-to-date, rigorous, USMLE review while you can:

It took you time, energy and money to complete your medical school application requirements and to pass the MCAT exam.

Both you and your parents have spent countless amounts of time, energy, and money for all the academic requirements asked of you (you can't make it to medical school without some sort of support structure).

If you belong to a family of physicians, failing on the USMLE Step 1 could make for some uncomfortable moments at family gatherings.

It would be far from impossible not to bump into one of your medical school classmates and see them wearing their scrubs and white coats while you struggle to walk faster so they will not recognize you.

Being left behind in medical school and starting all over again with the class below you is a little embarassing.

If you don't have the necessary good study habits to survive USMLE, just ask someone else for a little help. There is no embarassment there. Help can come in the form of a supporting community of student doctors, a formal USMLE review course, or an informal USMLE review with friends and classmates.

Some of the above situations are the worst case scenario. But all of the problems with USMLE exams can be prevented with the right study habits. Passing any academic examination all depends on one word: review. USMLE review will prepare you for the rigors of the exam. A regimented USMLE review can actually help you improve 20-40 percent on your previous USMLE (NBME test) scores. Don't get stuck revisiting the past and asking "What went wrong" when you could have taken a comprehensive USMLE review from the start.

When is an examination considered difficult? Just like any aspect of your medical education, the word "difficult" is subjective. An examination will be considered difficult when you lack the necessary preparation and review you need in order to pass a specific academic test.

Just like every academic test integrated in your medical education, you always need preparation. If you did not prepare, a moderately difficult examination will become very difficult. And the ease or difficulty of these tests will rely almost entirely upon your study techniques.

Furthermore, your study techniques will define how you will be able to retain necessary information to answer all the questions on your USMLE. The USMLE is a three-part licensing examination for medical students. Of course, you must pass all your academic examinations. And most of all, you must pass all the steps of USMLE.

Most medical students will participate in some form of a USMLE review program. For some, an online course best fits their needs, while others may choose a live or audio review. This USMLE review will play a major part in your passing or failing the examination. What happened if you did not prepare adequately on any test? You can expect either a failing score or a score that does not satisfy your expectations.

A USMLE Review usually consists of highly efficient medical doctors and specialists teaching material in a way that you, the student, can understand. These instructors should be fully equipped with the necessary credentials and training to facilitate a review of medical knowledge and adequately assist medical students in passing the USMLE Step 1, USMLE Step 2 CK, USMLE Step 2 CS or USMLE Step 3. However, if you don't utilize proper study techniques, even if the best specialists personally teach you in a USMLE Review, all will come to naught.

What specific study techniques can be helpful in conjunction with a formal or informal USMLE Review? Below are some helpful tips:

You should not overestimate your capabilities no matter how good your grades in your medical academic subjects.

You should put in mind that from the very first day you decided to take up medical education, preparation will always be a vital function you will need as a medical student.

The USMLE is not an easy examination but the degree of the ease or difficulty will be defined by how adequate or inadequate your preparation is.

You must define your goal in terms of passing the USMLE. Without any goal, your actions will have no direction.

You should be able to clearly set your goal and set specific actions to achieving the goal. It is also helpful to pick a specific score you want to achieve in the USMLE review tests as well as the actual USMLE Step 1, USMLE Step 2 CK, USMLE Step 2 CS and USMLE Step 3. This will further help you find appropriate initiative to achieve your objectives.

Preparation involves planning, and planning involves setting specific, measurable, attainable, realistic and time-bounded objectives. Without these objectives, the actions you need to take will be more difficult to define, and the outcome of those actions will be uncertain. Remember that perparing for the USMLE is like implementing a treatment for the patient. Without knowledge of what your goals of treatment are, you are at a loss as to what should be the prescription.

The United States Medical Licensure Examination (USMLE) is a series of examination which a medical student has to take in order obtain license in United State. The USMLE is sponsored by the Federation of State Medical Boards of the United States, Inc. (FSMB), and the National Board of Medical Examiners (NBME).

The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care.

Step 1 and Step 2 CK are given around the world at Prometric Test Centers (PTCs).

Step 3 is given at PTCs in the United States and its territories only. Once the passing score for step1 or step 2CK is achieved, one cannot retake the exam in order to achieve a higher score, therefore it is important to be prepared to achieve high score.

Step 2 CS has 12 patient cases. You will have 15 minutes for each patient encounter and 10 minutes to record each patient note. If you do not use the entire 15 minutes for the patient encounter, the remaining time will be added to the time you have to record the patient note. The testing session is approximately eight hours.

Step 3 has approximately 480 multiple-choice test items, divided into blocks of 35 to 50 items. You will have 45 to 60 minutes to complete each of these blocks. There are approximately nine computer-based case simulations, with one case in each block. You will have a maximum of 25 minutes to complete each of these blocks. Step 3 is administered in two eight-hour testing sessions.

USMLE Score Format

Once Steps 1, 2, or 3 of the USMLE is complete the scores are electronically transmitted to the NBME for scoring.

The first step of the scoring process is to convert the number of correct answers into two equivalent scores. The first score is a three-digit scaled score and the second is a two-digit scaled score. Three-digit scores will fall between 140 and 260 with the mean score being between 210 and 230. Two-digit scores are based on the three-digit score.

The two-digit score is calculated in such a way that a score of 75 always corresponds to the minimum passing score. This scoring method applies to all parts of the USMLE except for Step 2 CS. Step 2 of the USMLE contains two parts: Step 2 CK and Step 2 CS. Step 2 CS is assessed as either a pass or fail score. There is no numerical value assigned to this part of the test.

Pica is an eating disorder typically defined as the persistent ingestion of nonnutritive substances for a period of at least 1 month at an age at which this behavior is developmentally inappropriate (eg, >18-24 mo).

The definition is occasionally broadened to include the mouthing of nonnutritive substances.

Although pica is observed most frequently in children, it is the most common eating disorder in individuals with developmental disabilities.

In some societies, pica is a culturally sanctioned practice and is not considered to be pathologic. Pica may be benign, or it may have life-threatening consequences.

In children aged 18 months to 2 years, the ingestion and mouthing of nonnutritive substances is common and is not considered to be pathologic. Consider pica when the behavior is inappropriate to the developmental level of the individual, is not part of a culturally sanctioned practice, and does not occur exclusively during the course of another mental disorder (eg, schizophrenia).

If pica is associated with mental retardation or pervasive developmental disorder, it must be sufficiently severe to warrant independent clinical attention. In such patients, pica is typically considered to be a secondary diagnosis. Furthermore, the pica must last for a period of at least 1 month.

Pica is a serious behavioral problem because it can result in significant medical sequelae. The nature and amount of the ingested substance determine the medical sequelae.

Pica has been shown to be a predisposing factor in accidental ingestion of poisons, particularly in lead poisoning. The ingestion of bizarre or unusual substances has also resulted in other potentially life-threatening toxicities, such as hyperkalemia following cautopyreiophagia (ingestion of burnt match heads).

Exposure to infectious agents via ingestion of contaminated substances is another potential health hazard associated with pica, the nature of which varies with the content of the ingested material.

In particular, geophagia (soil or clay ingestion) has been associated with soil-borne parasitic infections, such as toxoplasmosis and toxocariasis.

If there's one thing you can say about 2011 from a health point of view, it's that it wasn't boring!From killer vitamins to scientists flip-flopping on the dangers of cell phones and salt, our heads are spinning as we sort through the headlines.Here are our picks for the year's most buzz-worthy stories.

1. Are Mammograms and Breast Self-Exams Worth It?

In 2009, the U.S. Preventive Services Task Force said most women don’t need mammograms until age 50. But a pair of studies released in April supported the idea that women in their 40s, especially minority women, should get annual mammograms. The tables turned again in July, when it was revealed that mammograms analyzed with a technology called computer-aided detection aren’t helpful in detecting cancers—only in producing false positives and causing unnecessary biopsies. But in September, researchers announced that both mammograms and breast self-exams are indeed useful for detecting breast cancer, including in younger women. The bottom line? Talk to your doctor.

2. Is Your Multivitamin Killing You?

Mom may have told you to take your vitamins, but a study published in October found that older women who took multivitamins and other dietary supplements—such as iron, folic acid, vitamin B, and zinc—actually had a higher risk of dying earlier. The study showed only an association—not cause and effect—and it didn’t ask the women about underlying health conditions for which they may have been taking the supplements.

3. K2 Synthetic Marijuana Sending Kids to ER

Just because it’s legal doesn’t mean it’s safe. That’s the message doctors hope to send to teenagers smoking K2, a synthetic form of marijuana. In November, the American Association of Poison Control Centers revealed that, since the beginning of 2010, it had received nearly 2,000 reports of people becoming ill (sometimes with life-threatening symptoms) after smoking the herb, which also goes by the names Spice, Yucatan Fire, Genie, and Fire and Ice. Many users are sent to the emergency room with racing hearts, extreme anxiety, and hallucinations.

3. Pregnant Woman Runs Marathon, Gives Birth Hours Later

Race-day spectators watched in awe as Amber Miller crossed the finish line at the Chicago Marathon in October—and proceeded to go into labor. When she gave birth to a healthy baby hours later, the question on everyone’s mind was, “Was that safe!?” Experts have long recommended exercise during pregnancy, but this takes it to an extreme. (And here’s perhaps the biggest news of all: She still finished before her husband!)

4. Turn Brown Eyes Blue With New Laser

For when colored contacts just aren’t permanent enough, a California company claims its new laser technology can change brown eyes blue. The technology won’t be available in the United States for at least three years, but it’s already sparking questions about genetic identity and family ties. (Eye color is one of the inevitable traits passed down from parents to children.) In November, “Time”’s Healthland blog published a story on why the idea feels “off-color."

5. Barefoot Running Shoes Are Hot

They’ve been hailed as the “real” way to run, to prevent injury and to reverse the harm that regular running shoes with lots of padding under the heel cause to our natural gait. But as more people have jumped on the barefoot-running wagon, researchers have begun to caution about potential injuries caused by switching shoe styles too quickly. These minimalist shoes, which contain little if any padding and encourage runners to land on their mid-foot or forefoot, lack the support and cushioning many runners need, especially if they continue to land on their heels in their new shoes.

6. No TV Before Age 2, Say Pediatricians

The recommendation has been around for a few years, but in October the American Academy of Pediatrics made it official: No television is the best television for children under the 2. Kids instead should be encouraged to think creatively during periods of unstructured “free play,” they said. The announcement was a blow to companies that market educational videos for babies—as well as any parents enjoying a rare moment of peace and quiet!

7. High-Salt Diets Might Kill You—but Low-Salt Diets Might Too

We’ve always been told that too much sodium raises your blood pressure, but a report published in May found that death from cardiovascular problems was 56 percent higher for men who ate the least amount of sodium. Although some people with hypertension should lower their salt intake, experts say, reducing sodium isn’t necessarily good for everyone. To make matters more confusing, a large, 15-year study published in July found that people who eat more sodium and less potassium die sooner of heart problems than those who consume the opposite.

8. Baby Shampoo May Be Toxic

It’s known as the no-tears formula, but Johnson & Johnson’s baby shampoo should perhaps be recognized for something else: toxic chemicals that are still lurking in some formulas, says the Campaign for Safe Cosmetics. In November, the watchdog group sent the company a letter urging it to stop using formaldehyde-releasing substances in its popular shampoo brand. Johnson & Johnson responded by saying that it is gradually phasing out such harmful chemicals, but did not comment on this specific product.

9. Cellphones May or May Not Cause Cancer

The world breathed a collective sigh of relief in February when a British study found no link between cell phones and brain tumors. But before you can say “OMG”, cancer experts told the World Health Organization in May that cell phones may actually still cause brain cancer. The most recent study on the topic, released in July, found that cell phones don’t seem to pose a cancer risk to kids who use them regularly—but the researchers cautioned that more research is needed.

10. Speech-Slurring Emmy Anchor: Stroke, Drunk, or Migraine?

Reporter Serene Branson’s bizarre telecast live from the Emmys in February made headlines for what she didn’t say: Fumbling her words and uttering nonsensical syllables, she caused news outlets to wonder whether she’d had a stroke on air. Some even questioned whether she was drunk or on drugs. Medical professionals examined Branson after the incident, and doctors revealed in the following days that she had actually suffered a short-term complex migraine.

HE suddenly saw himself in the mirror and start crying after he discovered his first gray hair (gasp!) THIS IS some anti-aging foods :

Berries:All black and blue berries such as blackberries, blueberries, blackcurrants and black grapes contain phytochemicals known as flavonoids-powerful antioxidants which help to protect the body against damage caused by free radicals and aging.

Ginger:This spicy root can boost the digestive and circulatory systems, which can be useful for older people. Ginger may also help to alleviate rheumatic aches and pains

Nuts:Most varieties of nuts are good sources of minerals, particularly walnuts and brazi nuts. Walnuts, although high in calories, are rich in potassium, magnesium, iron, zinc, copper and selenium. Adding nuts to your diet (sprinkle them on salads and desserts) can enhance the functioning of your digestive and immune systems, improve your skin help control prevent cancer. Nuts may also help control cholesterol levels. Never eat rancid nuts, however, as they have been linked to a high incidence of free radicals.

Soya:Menopausal women might find that soya helps to maintain oestrogen levels. Soya may alleviate menopausal hot flush and protect against Alzheimer's disease, osteoporosis and heart disease. Look out for fermented soya products, which are more easily digested, therefore more nutritional, and do not generally cause food intolerances. You may want to check that soya products have not been genetically modified. Soya should not be confused with soya sauce, which is full of salt and should be used sparingly, if at all.

Whole meal pasta and rice:Complex carbohydrates provide a consistent supply of energy throughout the day and should make up the bulk of your diet. Wholemeal pasta is an excellent complex carbohydrate. It is high in fibre and contains twice the amount of iron as normal pasta. Brown rice is another recommended complex carbohydrate, which is high in fibre and B vitamins.

Watermelon:Both the flesh and seeds of the watermelon are nutritious so try blending them together in a food processor and drinking as a juice. The flesh contain vitamin A, B and C ; the seeds contain selenium, essential fats, zinc and vitamin E, all of which help against free radical damage and aging.

Water:Drink at least 8 glasses of water every day in order to remain healthy. Water helps us to get rid of the toxins and unwanted waste materials from your body.Don't rely on thirst; this sensation diminishes with age. Drink often and choose from nutritious liquids, including 100% fruit and vegetable juices, skim or low fat milk, broths, sparkling water, and teas. You can also get fluids from foods, especially those that are liquid at room temperature. Try gelatin, frozen yogurt, soups, watermelon, pickles, oranges, lettuce, tomatoes, etc.

Avocado:This fruit, which is usually eaten as a vegetable, is a good source of healthy monounsaturated fat that may help to reduce level of a bad type of cholesterol in body. Avocado is a good source of vitamin E and can help to maintain healthy skin and prevent skin aging (vitamin E may also help alleviate menopausal hot flushes). It is rich in potassium which helps prevent fluid retention and high blood pressure.

Fish:Thirty years ago, researchers began to study why the native Inuits of Alaska were remarkably free of heart disease. The reason, scientists now think, is the extraordinary amount of fish they consume. Fish is an abundant source of omega-3 fats, which help prevent cholesterol buildup in arteries and protect against abnormal heart rhythms. Eat some tonight with a healthy fish recipe.

Olive Oil:Four decades ago, researchers from the Seven Countries Study concluded that the monounsaturated fats in olive oil were largely responsible for the low rates of heart disease and cancer on the Greek island of Crete. Now we know that olive oil also contains polyphenols, powerful antioxidants that may help prevent age-related diseases.

Yogurt:In the 1970s, Soviet Georgia was rumored to have more centenarians per capita than any other country. Reports at the time claimed that the secret of their long lives was yogurt, a food ubiquitous in their diets. While the age-defying powers of yogurt never have been proved directly, yogurt is rich in calcium, which helps stave off osteoporosis and contains “good bacteria” that help maintain gut health and diminish the incidence of age-related intestinal illness.

Cruciferous vegetables:

The family of Cruciferous vegetables includes cabbage, cauliflower, broccoli, kale, turnip, brussels sprouts, radish and watercress. Cruciferous vegetables assist the body in its fight against toxins and cancer. You should try to consume at least 115g/40z(of any one or a combination) of these vegetables on a daily basis. If possible, eat them row or very lightly cooked so that the important enzymes remain intact

Are you feeling stressed ? Don't worry, here is some helpful food for you to calm your nerves. Try eating carbohydrates. The effect that carbohydrates have is their ability to produce serotonin. Serotonin gives you a calm and relaxed feeling.

It is also important to have vitamin B6 as it ensures the production of serotonin. When the blood sugar runs dry ,it depends upon glycogen in the liver. Therefore it is very important for the liver to function well in order to ensure a good functioning of the nerves. The following foods have been found to be beneficial for the nerves.

Carbohydrate rich food like pop corn, oatmeal, dry cereal without milk, berries which help in fighting cortisol which is a stress hormone in the body.

Although cholesterol has gotten a bad rap, it isn't quite the culprit it's made out to be. Your body actually needs cholesterol, and your liver makes about 1,000 mg of the stuff every day.

In addition to cholesterol produced by the body, we also get cholesterol from animal products. For example, dairy products, meat, fish and egg yolks contain cholesterol. Foods derived entirely from plants, such as vegetables, fruits and grains, do not contain cholesterol.

It is recommended that less than 300 mg of cholesterol should be consumed per day. According to the American Heart Association, men typically ingest about 337 mg of cholesterol daily, and women ingest about 217 mg.

Reading Food Labels

Physicians most often recommend cholesterol-restricted diets for patients with significantly elevated cholesterol levels and known heart disease and sometimes for those with a high risk of cardiovascular disease. To follow such a diet, it's important to read the nutrition labels on foods before consuming.

Each food label should include milligrams of cholesterol per serving. Don't forget to look at the serving size as well. Sometimes products can seem low in cholesterol, but if you eat more than the recommended servings at one sitting, then you can end up consuming a lot more cholesterol than you intended.

You may be confused by the percentages included on the label, marked as "% of daily value." The daily value -- or daily reference value -- is the USDA's term for daily nutritional requirements, based on a 2,000-calorie diet. But when counting cholesterol, it's best to overlook these percentages and focus on limiting your daily consumption to 300 mg or less.

Foods Without Labels

When shopping in certain areas of the grocery store many foods do not have labels, such as fruits, vegetables and other plant products, but remember that these foods don't have any cholesterol. For other products, the USDA maintains a searchable nutrient database. This database provides cholesterol contents for many different foods. All you have to do is use a keyword, like "turkey," and scroll down until you find the turkey bacon that you ordered.

You must also be careful when you eat out, although many restaurants now offer healthy choices. You may want to ask the restaurant's staff for more information about their menu choices.

What About Fats?

In addition to watching the cholesterol content of your foods, you'll probably want to keep tabs on saturated fat and trans fats.

According to the USDA, saturated fats can raise "bad cholesterol" or the low-density lipoproteins (LDL); this is the artery-clogging stuff that can lead to heart attacks or strokes.

Trans fats have also been linked to increased LDL levels. The USDA recommends limiting saturated and trans fats as much as possible.

Unsaturated fats, however, can be good for the body. According to the USDA, most of the fat in your diet should come from unsaturated fats. Seeds, nuts and fish are all good sources of these healthy, unsaturated fats.

1. Short of surgery, there is no simple process to quickly remove the fat. Reducing it requires time, patience and work.

2. When you exercise, make sure your movements are smooth and controlled.

3. Do your best to not arch your back during your abdominal workout. Arching your back can strain the muscles in your lower back and increase the length of time it will take to lose the fat.

4. Lots of people think that, in order for exercise to be effective, exercise must be done until the person feels out of breath and physically tapped. This couldn't be farther from the truth. Exercise until it feels uncomfortable and then cool down. As time goes on, you'll find that the time it takes to feel winded or uncomfortable gets longer and longer.

5. Sit ups, when not paired with a full body workout do not actually flatten your stomach. In fact, unless you are working your entire abdominal region (and the rest of your body), sit ups will tone your abdominal muscles, making them more pronounced behind the layer of fat--making your stomach fat even more obvious!

6. Do some crunches when you would normally be lying around and doing something passive (like watching television or listening to music). Crunches are one of the best exercises you can do to work your abdominal muscle area.

7. Keep your workout routine varied. The more you do an exercise, the more your muscles will become used to it and the less effect it will have on your muscle tone and it will make it harder for you to get into shape.

8. Make sure that you are eating a healthy diet. All of the exercise in the world won't do you any good if you aren't eating healthy as well. Healthy foods have fewer calories and are easier for your body to digest.

9. Stay away from saturated fats and foods containing high fructose corn syrup. Saturated fat and high fructose corn syrup are two of the leading reasons why people have problems with belly fat in the first place.

10. Maintain proper posture. By sitting up straight you will be able to reduce the appearance of your stomach fat. Proper posture will also help you when you work out and you'll find that you have less muscle aches!

Persistent pain is common among older persons, who are more likely to suffer from problems such as arthritis and other chronic conditions. The person with dementia often has trouble communicating his or her feelings or thoughts—and this can mean the inability to tell you if a physical problem, such as pain, exists. If your loved one has dementia, determining if he or she is experiencing pain may be up to you. Careful observation can reveal important clues to let you know that he or she is experiencing pain. These clues can include:

During movement: Signs could be grimacing or groaning during personal care (such as bathing), walking, or transferring (from bed to chair, for example).

Without movement: Does your loved one appear agitated or have other behavioral changes, such as trouble sleeping, loss of appetite, or reclusiveness?

If you see any of these signs, talk to your healthcare provider as soon as possible, telling him or her what you have noticed and giving examples. Focus on when the pain occurs, and how it seems to be experienced (burning? aching? stabbing?) and whether it occurs with or without movement. Tell your healthcare provider what, if anything, relieves the pain. It is important to provide your healthcare professional with a history of all prescription and over-the-counter medicines your loved one now takes and has taken in the past, writing down all medications and dosages.

While arthritis is the most common cause of pain for people over age 65, circulatory problems, shingles, certain bowel diseases and cancer are other common reasons for pain in older people. Nerve damage can also cause severe and constant pain. Some people think that pain is natural with old age or that when older people are not clear in explaining the cause of their pain they are just complaining. Both of these views are wrong. There is almost always a real problem behind the aches and pains. Pain can lead to other problems. People with pain may lose the ability to move around and do everyday activities. They may have trouble sleeping, experience bad moods and have a poor self-image. People with pain also often have anxiety or depression. They may be at greater risk for falls, weight loss, poor concentration and difficulties with relationships. Most pain can be controlled, usually through a combination of drug and non-drug strategies, which should be discussed with a healthcare provider. Caring for someone in pain or at risk for pain is often an ongoing process. As various strategies are tried, it may help to keep in mind two basic principles:

Believe the person you are caring for. People with pain are the only ones who know how much pain they are feeling. Pain is whatever the older person says it is and exists whenever he or she says it does. If people with pain feel that others do not believe them, they become upset and may stop reporting their pain accurately. This makes controlling the pain more difficult.

Every person has the right to good pain control. Your job as a caregiver is to make sure that good pain control is provided. Tell health professionals if pain does not improve with treatment and ask them to try new treatments until the pain is controlled. Your goals are to help evaluate and relieve pain and to keep health professionals informed about pain levels and responses to pain treatments.

What You Can Do to Help Evaluate pain:

Ask about the pain. No medical test can tell you whether or not a person is in pain. The best way to find out if a person is in pain is to ask. A good way of asking is to say, “How bad is your pain right now on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain you ever had?” Don't contradict or argue about these ratings.

Listen for words other than "pain." Older people may use different words to describe their pain, such as “discomfort,” “soreness” or “ache.”

Look for behavior or body language that could be a response to pain. The older person may be unwilling to report pain or be unable to communicate about pain in words. Behaviors to look for include facial expressions or groaning when moved

What is Sinusitis?If you've never given your sinuses much thought, a bout of sinusitis can make you think about nothing else. Sinusitis is used to describe any condition where the sinuses become inflamed. Sinuses are the four pairs of air-filled pockets located around the nose and eyes. They are designed to strengthen your skull, filter the air that comes through your nose, add resonance to your voice and help remove mucus from the body. If they become blocked, mucus can't drain properly and air pressure can build up in the sinuses, resulting in the familiar headache and congestion. Although "sinusitis" and "sinus infection" are often used interchangeably, an infection is only one of many possible causes. The sinuses can also become inflamed by allergens or other environmental irritants, or if you have structural abnormalities in your nose that interfere with sinus functioning. Your doctor might suspect sinusitis if you show up complaining of a headache, especially one that gets worse when you lower your head, tenderness around the eyes and nose, and thick greenish-yellow nasal discharge. However, not all cases of sinusitis are created equal. One of the major distinctions that physicians use when diagnosing sinusitis is whether it's an acute or a chronic problem. Acute SinusitisAn acute infection is one that crops up seemingly out of nowhere. You could be breathing free and easy one day and then struck with an unbearable sinus headache the next. In most cases, acute sinusitis occurs after a particularly nasty cold. The cold virus causes the mucous membranes in your sinuses to swell and become less effective at draining mucus. The mucus and other material sitting around in your sinuses becomes perfect food for bacteria, leading to a bacterial infection in the sinuses. Although a bacterial infection following the cold is the most common cause of acute sinusitis, it can also be caused by allergies or viral and fungal infections. If you have symptoms of sinusitis, your doctor will probably examine you and use a long swab to take samples from your nasal passages and sinuses. These samples can then be analyzed for signs of bacterial or fungal infection. Nasal swabbing doesn't usually hurt, but it can be uncomfortable, especially if you have structural abnormalities like a deviated septum. Acute sinusitis is usually easy to treat. In some cases, it clears up on its own, but anti-inflammatory painkillers such as ibuprofen and aspirin can help alleviate most symptoms. Your physician might also prescribe antibiotics or allergy medication, depending on the cause of your sinusitis. Washing the sinuses out with saline solution (using a saline nasal spray, a sinus cleansing kit or neti-pot) can also help to alleviate the symptoms of acute sinusitis. Chronic SinusitisIf you have sinus headaches and congestion that never seem to go away, or that go away and come back repeatedly, you could be experiencing chronic sinusitis. You have sinus passages that are constantly inflamed, and this causes chronic headaches, difficulty breathing and postnasal drip into the throat. Unfortunately, in many cases the cause of chronic sinusitis is unknown. Allergies may be a factor, in addition to tiny nasal polyps that can aggravate the sinuses and cause chronic sinusitis. Chronic sinusitis can be tough to treat because it can be difficult to figure out what's causing it. Acute flare-ups can usually be treated with painkillers, although this won't fix the underlying problem. Your physician might suggest that you wash your sinuses out regularly with saline solution to remove some of the mucus and keep your sinuses from drying out. In extreme circumstances, surgery to remove polyps or enlarge the sinus passages may be recommended. Whichever type of sinusitis you have, do your best to treat it. A nasty little sinus infection can quickly turn into a more severe one that can spread throughout your body. So, if you find yourself complaining of a sinus headache and congestion for more than a couple of days, visit your doctor to discuss treatment options.

Sickle cell anemia is a painful, inherited condition in which the red blood cells become abnormally shaped. It may lead to pain or a number of other serious complications including stroke, life–threatening infection or end-organ damage.

Red blood cells transport vital oxygen to the limbs and organs. These cells are normally disc–shaped. In people with sickle cell anemia, a large number of these red blood cells become sickle- or crescent–shaped.Hemoglobin, a protein molecule present in all red blood cells, is responsible for transporting oxygen from the lungs to the tissues around the body. However, in people with sickle cell anemia, a sickle–shaped red blood cell develops as a result of the presence of an abnormal hemoglobin called hemoglobin S. Normally red blood cells contain hemoglobin A. But with hemoglobin S, there is a reduction in the amount of oxygen transported in the red blood cells. As a result of this reduced oxygen, the cells change shape. These sickle-shaped cells are harmful because they often get stuck in small blood vessels, obstructing the flow of blood. This can lead to a number of complications, including recurrent episodes of pain known as asvaso-occlusive sickle cell crises. These structurally abnormal cells also become very fragile and begin to be broken down prematurely, at a rate faster than the body can replace them. As a result, patients with sickle cell anemia often have a lower-than-normal number of red blood cells in their blood, condition called anemia. This can lead to a number of symptoms including fatigue, jaundice (yellowing of skin and eyes) and shortness of breath.Sickle cell anemia can affect only someone who has inherited hemoglobin S from both parents. A person who inherits hemoglobin S from only one parent can have sickle cell trait (AS). Known as carriers, these people with sickle cell trait usually have no symptoms. They can, however, pass the trait onto their children. To determine if a person has sickle cell anemia or sickle cell trait, physicians may order a number of blood tests (e.g., hemoglobin electrophoresis, sickle cell test). Newborns are routinely screened for the abnormal gene in many states. Adults, older children and fetuses can also be screened. According to the Sickle Cell Disease Association of America, there are approximately 70,000 people living with the sickle cell anemia in the United States. Most of these patients are African American and Hispanic. Currently, bone marrow transplant is the only cure for sickle cell anemia. The procedure, however, is risky, and it is often difficult to find a suitable donor. When a bone marrow transplant is not an option, the focus of treatment is on relieving pain and preventing crises and other complications

Scoliosis is an abnormal sideways curvature of the spine that is usually painless, but can result in chronic back pain if left untreated. Severe cases in young children can cause deformities, impair development and be life-threatening.

Scoliosis is most often found in patients between 10 and 14 years old, though the condition can also affect infants. In infancy, boys are at higher risk for scoliosis than girls, but girls are at much higher risk for developing scoliosis after age 3. Regular checkups by the primary care physician are necessary to notice this problem at an early phase, with early treatment intervention.In most people, the spine appears straight when viewed from behind. However, patients with scoliosis have one or more side–to–side spinal curvatures. Scoliosis is diagnosed when a patient has a spinal curvature greater than 10 degrees.Scoliosis patients who wear a back brace over an extended period of time can usually prevent further curvature of the spine. Left untreated, scoliosis can become more severe, resulting in ongoing back pain and breathing difficulties. In severe cases of scoliosis, surgery may be necessary to restore the spine.

About scoliosis

Scoliosis is an abnormal sideways curvature of the spine that is typically found in children and adolescents. In most cases, scoliosis is painless. However, it can become gradually more severe if left untreated, resulting in chronic back pain. In young children, severe cases can cause deformities, impair development and be life-threatening.In most people, the spine appears straight when viewed from behind, with the lower back bending slightly inward and the upper back bowing a little outward. However, scoliosis patients have one or more side–to–side spinal curvatures that can appear in the shape of an “s” or a “c.” Though this curve is not always visible, it can be seen from behind in many patients. This is especially true in severe cases. Scoliosis, which comes from the Greek word for “crooked,” is usually diagnosed when a patient has a spinal curvature greater than 10 degrees. It is most often found in patients between 10 and 14 years old, although it can be present in infancy. Infant boys are at higher risk for scoliosis than girls, but girls are at much higher risk for developing scoliosis after age 3. The cause of about 80 to 85 percent of all scoliosis cases is unknown (idiopathic), according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The most common form of scoliosis is known as adolescent idiopathic scoliosis, which occurs when a patient is 10 years old or older. Other forms of scoliosis include infantile idiopathic scoliosis (birth to 3 years) and juvenile idiopathic scoliosis (ages 3 to 10 years). Scoliosis is less common in adults.

iPhone AppStore Secrets - Pinch Media

30,000,000 Downloads?! (Actually, it’s a fair bit more than that by now.) • Since AppStore launch, Pinch Media has provided developers with an analyUcs library to monitor app usage – unique users, sessions, usage Ume, etc. • Since AppStore launch we’ve also been collecUng every bit of detail possible from the AppStore – rankings, price changes, you name it – and tying it back to our analyUcs. • Our stuﬀ’s in a few hundred applicaUons right now – it’s been in the #1 free and paid applicaUon several Umes each, and has been in at least ten of the top 100 free applicaUons for a while now. • With all of this data, you learn a few things.

ApplicaUon Rankings (How does the AppStore work, anyway?) For every ranked list on the AppStore, here’s a good rule of thumb: 24‐hour rolling window of units downloaded (So bunch up your publicity.)

What do you get by appearing on a list? • Appearing on a top 100 list increases daily new users by an average of 2.3x. • Greater gains result from appearing in the top 25 and top 10 lists – more variable, but oaen an order of magnitude. • However, it’s not permanent. Apple’s AppStore is structured for maximum turnover.

Case Study A: Well‐Timed Price Cut

Case Study B: Not‐So‐Well Timed

Case Study C: CounterproducUve?

In general… • Don’t mess with a posiUve download trend. • Decreasing price is oaen worthwhile. • Aaer you’ve been broadly exposed, experiments have less eﬀect. The average price cut increased demand by 130%. The average price increase drops demand to 25%.

What do I need to get on a list? For free applicaUons: Top 25 Top 100 six months ago 10,000 1,000 three months ago 11,000 1,500 today 20,000 5,000 (Apple had a big Christmas!)

Case Study D: Happy Holidays

Do I have a community? (aka ‘How much is my app used?’) • So you’ve got a million downloads – congrats! But what percentage use your applicaUon the next day? The day aaer? • The biggest applicaUons in our system have +3MM downloads – but what kind of acUve user base does a download translate into?

In other words… • Users stop using the average applicaUons prely quickly. Long‐term audiences are generally 1% of total downloads. • Paid applicaUons generally retain their users longer than free applicaUons, although the drop‐oﬀ is sUll prely steep. • Sports seems beler at retaining users over the short term; entertainment at retaining users over the long term.

How long are they using it? • For certain applicaUons, the length of Ume users use the applicaUon is important. • Branded applicaUons care deeply about engagement. • ApplicaUons showing ads periodically also care about session length, for obvious reasons. • In general, every second the app’s open is a second it can be seen by or recommended to others.

So should I give it away or not? • Anyone browsing the top free applicaUons knows that adverUsing is an opUon. • The biggest player is AdMob, but Pinch Media has some partnerships with ad networks that supply some of these ads. • However… I used to be much more enthusiasUc about adverUsing than I am today. Here’s why:

Total ApplicaHon Runs Since First Use 12 10 Total ApplicaHon Runs 8 6 4 2 0 1 11 21 31 41 51 61 71 81 Days Since First Use

Average ‘free vs. paid’ raUos: • for total unique users: 7.5 to 1 • for total number of Umes used: 6.6 to 1 • for total Ume spent using the applicaUon: 3.9 to 1

Answer: Hell no. Earning $0.70 in 80 sessions requires revenue of $8.75 per thousand runs. If you can show one ad per session, that’s an $8.75 CPM. Right now, with the ad market how it is, adverUsing rates of $0.50‐$2.00 CPM are much more typical. The typical applicaUon would have to bombard its users with ads to beat the money it’d make from paid sales.

But adverUsing isn’t always a bad idea. • Some applicaUons beneﬁt from network eﬀects, and get far more than 6.6x the users they’d get if they charged. • Some applicaUons are excepUonally ‘sUcky’ – users use the app far more than average. • Some applicaUons – generally, ones catering to people with money – can command beler adverUsing rates than usual.

To sum up… • Only a few (<5%) high‐performing applicaUons are suitable for adverUsing right now, and you don’t know if you’ve got one unUl aaer launch. • In other words ‐ unless there’s something inherent about the app that screams free, sell it. • Install analyUcs in your applicaUon and watch your sessions per user over Ume. Within a few weeks, you’ll know if you’ve got a sUcky applicaUon. • Only release an ad‐supported version when you have data strongly indicaUng success.

Again, summing up ‐ • Usage Ume declines by almost a third in the ﬁrst month aaer use, stabilizing at just under ﬁve minutes. • Paid applicaUons see slightly more use soon aaer installaUon, and are used for slightly longer periods. • The biggest usage diﬀerenUator is category – games are used for longer periods than any other type of applicaUon.

This was actually a sneak preview • AppStore‐wide reports are being generated daily and will be incorporated into Pinch Media’s reporUng site in the near future. • Any applicaUon using our analyUcs library and acUvely sending in data gets access to all ecosystem‐wide reporUng for free. • Pinch Media wants to know what else you want baked into this reporUng.

Firefox 4 - Motivation 1. Who uses Firefox? 2. What are those people trying to do? 3. How can Firefox be the best tool for the job? 4. What does Firefox need to succeed? 5. How can Firefox help lead the Open Web forward? 5

Firefox 4 - Motivation • What are those people trying to do? • Users: interact, create, ﬁnd, learn, experience, control • Developers: build, create, express, impress, reach How can we lead How can Firefox be the Open Web? the best tool for this? What does Firefox need to succeed? 7

Firefox Platform: Doing two things at once • in 2009 and early 2010 we proved that we can split our focus • once we branch for beta, must have plans in place • priority will be given to full content/chrome process separation • will start developing & communicating those plans next month PLANS MIGHT CHANGE (please don’t overreport)